Intro to Transplantation
Transplantation of vital human organs, one of the most complex medical endeavors, is now a common lifesaving therapy for victims suffering from end stage kidney, liver, heart, lung and pancreas failure. Also transplantation of various tissues like skin, bone, and corneas can restore thousands of people to normal, active and productive lives. The need for organs and tissues for transplantation continues to exceed supply in all areas of the country. Thousands of chronically ill people are awaiting transplantation and the waiting list for organs grows every day. A very small percentage of deaths occur in such a way that organ donation is possible. It is important that every potential donor is given the best possible opportunity to donate. Tissue donation is possible in many more people than organ donation and the need for tissue is great also.
To better understand the problems that confront transplant physicians today, each of the organs clinically transplanted must be evaluated individually. Although each organ transplanted confronts physicians with a different host of technical considerations, all organ transplants have two things in common:
1. A transplanted organ is a foreign tissue and is subject to rejection. Here, biochemistry and immunology find their challenge. Although rejection can be clinically challenging, enormous strides have been made in the medical management of transplant recipients.
2. A transplanted organ must be a living organ. Unlike bone, skin and corneas, which can be recovered several hours after cardiac death, vital organs must be recovered from a donor with blood flow or immediately after circulation ceases.
For patients with end stage renal diseases (ESRD), there are two available therapies: dialysis and transplantation. Although some patients respond well to dialysis, many do not. Children maintained with chronic dialysis do not grow at normal rates. Adults frequently must give up their jobs and lose their roles as providers and heads of their families. Physical and financial dependency often leads to emotional dependency and depression. The majority of individuals with ESRD also suffer from a myriad of medical complications, including chronic anemia, muscle wasting, extensive bone deterioration and peripheral nerve damage. The incidence of suicide among dialysis patients is considerably greater than it is for the general population. For those patients who adapt poorly to dialysis, the only hope for a normal life is a new kidney-a real kidney. Kidney transplants make up over 60% of organ transplants and over 16, 000 kidneys are transplanted annually throughout the United States.
Ninety percent of the patients receiving kidney transplants from deceased donors have normal renal function at the end of the first postoperative year. Right now in our area, there are more than 250 patients waiting for a phone call that tells them a suitable kidney has been found for them. Nationally, there are over 96, 000 ESRD patients on renal transplant waiting lists, and the list continues to grow.
There are more than 2,000 heart transplants performed annually in the USA with a waitlist of around 3,500 patients. The waitlist number and deaths on the waitlist has remained relatively stable over the last 10 years. Mechanical assist devices are being used as destination therapy for a number of patients as an alternative to transplant. Those devices are also used as a bridge to transplant to buy time until a donated heart becomes available. The 1 year survival following heart transplant approaches 90%.
The liver is the second most common organ transplanted and the results have improved dramatically over the years. The one year survival following liver transplant taking all patients transplanted is greater than 86%. In some age groups like pediatrics and younger adults the one year survival is over 90%. There are many liver recipients that lead normal lives.
Patients with severe type 1 diabetes may be candidates for pancreas transplant. This can be as an isolated pancreas transplant but more commonly it is done in association with a kidney transplant in patients where diabetes has resulted in kidney failure. The one year survival following pancreas transplant is over 90%.
Heart and lungs are transplanted en block in recipients suffering from end stage lung disease with cardiac failure. A very limited number of these transplants are performed at a very few centers that do this procedure in a highly selected group of patients. The one year survival following heart lung transplant is about 70%.
Single/Double Lung Transplantation:
Single/ double lung transplants are performed on patients suffering from idiopathic pulmonary fibrosis, pulmonary hypertension, emphysema and related end-stage pulmonary disease. There are about 1,750 lung transplants done annually in the USA.
The Problem & The Solution
Organs for transplant are a scarce resource and limits the number of lives that can be saved by transplantation. Gallup polls have found that more than 80-90% of Americans are willing to donate their organs and tissues for transplantation after death. In our experience, grieving families welcome an opportunity to consider organ and tissue donation. The knowledge that others' lives have been enhanced through the gift of a loved one's organs and tissues is generally a strong solace for a family struggling to accept what they feel is a meaningless death. The vast majority of deaths that could be organ donors are unexpected and often tragic. Approaching a family about donation at the time of their loved ones death takes special skills and it is best done by someone with advanced training in this specific are and the special ability to communicate with families at their darkest hour. ARORA has a staff of family service coordinators that are skilled in this process. ARORA just needs a timely referral to get our staff in position to talk to the family when it becomes appropriate.